Alcoholic Liver Disease: This is a common cause of deranged liver function tests (LFTs) in adults, especially males. The presence of acidosis could be due to the metabolic effects of alcohol or associated conditions like alcoholic ketoacidosis.

Viral Hepatitis: Acute or chronic viral hepatitis (e.g., hepatitis B or C) can cause deranged LFTs. Acidosis might occur in severe cases, especially if there's significant liver dysfunction or an acute flare.
Non-Alcoholic Fatty Liver Disease (NAFLD): Given the rising prevalence of NAFLD and its potential to cause significant liver dysfunction, it's a plausible diagnosis, especially if the patient has risk factors like obesity or diabetes.
Drug-Induced Liver Injury: Various medications and drugs can cause liver injury, leading to deranged LFTs. Acidosis could be a consequence of severe liver dysfunction or a separate effect of the drug.

Acetaminophen Overdose: This is a medical emergency that can cause severe liver injury and acidosis. Even if unlikely, missing this diagnosis could be fatal, so it must always be considered, especially with deranged LFTs and acidosis.
Wilson's Disease: Although rare, Wilson's disease can present with liver dysfunction and metabolic disturbances, including acidosis. It's crucial not to miss this diagnosis due to its potential for severe liver damage and the availability of specific treatments.

Autoimmune Hepatitis: This condition can cause deranged LFTs and, in severe cases, lead to liver failure, which might result in acidosis. It's less common but should be considered, especially if other causes are ruled out.
Budd-Chiari Syndrome: This rare condition, caused by hepatic vein thrombosis, can lead to liver dysfunction and potentially acidosis due to liver congestion and failure. It's an important diagnosis to consider, especially in patients with risk factors for thrombosis.